Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The Glasgow Coma Scale (GCS) is the most universally accepted system for grading level of consciousness. Predicting outcome is particularly difficult in poor grade aneurysmal subarachnoid haemorrhage (aSAH) patients. We hypothesised that the GCS and individual examination components would correlate with long-term outcome and have varying prognostic value depending on assessment time points. ⋯ Long-term follow-up is necessary when evaluating recovery after aSAH, as outcomes improve significantly during the first year. The GCS and its individual components correlate well with long-term outcome. Admission motor examination and spontaneous eye opening during hospitalisation are most predictive of favourable recovery.
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Case Reports
Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt.
We report on two patients with rare major intratumoral hemorrhage following ventriculoperitoneal shunt in posterior fossa tumors. A 28-year-old woman with a midline posterior fossa lesion, whose imaging features suggested a fourth ventricular ependymoma with obstructive hydrocephalus, was subjected to a right ventriculoperitoneal shunt. Her consciousness deteriorated, and she experienced massive intratumoral hemorrhage and later died. ⋯ She also developed a massive tumor bleed following a ventriculoperitoneal shunt and was subjected to emergency decompression of the tumor with the bleeding. She remained vegetative at discharge and died 18 months later. Intratumoral hemorrhage is a rare but important cause of morbidity and mortality in patients with posterior fossa tumors who undergo ventriculoperitoneal shunt.
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Airway management during anaesthesia for intracranial procedures has traditionally been by endotracheal intubation. We present three cases of radiological coiling of cerebral aneurysms during which a supraglottic airway device was used. This avoided the need for endotracheal intubation and the associated risks. We believe the use of a supraglottic airway device is a safe alternative to endotracheal intubation during coiling of cerebral aneurysms.
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Clinical Trial
Perioperative complications and clinical outcomes of multilevel circumferential lumbar spinal fusion in the elderly.
Combined anterior-posterior lumbar fusion across multiple levels is thought to be associated with increased perioperative morbidity and worse clinical outcomes when performed in elderly patients. We conducted a retrospective review of the medical, surgical, and radiological records of 73 patients who underwent multilevel anterior lumbar interbody fusion (ALIF) with posterolateral lumbar fusion with instrumentation for symptomatic lumbar degenerative disc disease. Mean follow-up was 19 months. ⋯ There were no significant differences in the number of levels fused, operative time, mean length of hospital stay or perioperative complication rates in either group. Similarly, there were no statistically significant differences in the improvement in back pain or in the rates of fusion between the groups at last follow-up. Perioperative events, intermediate-term clinical outcomes, and fusion rates after multilevel 360-degree lumbar fusion in the elderly are comparable to those of younger patients.
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Clinical Trial
Introduction of an acute stroke team: an effective approach to hasten assessment and management of stroke in the emergency department.
Recombinant tissue plasminogen activator (rtPA) reduces the combined endpoint of death and disability if given within three hours of onset of ischaemic stroke. However few patients receive rtPA, with delays in in-hospital evaluation and treatment being key barriers to therapy. The Austin Hospital Acute Stroke Team (AST) was introduced with the aim of improving the speed of assessment and management of acute stroke patients presenting to the emergency department. ⋯ Onset-needle time and door-needle times significantly improved following introduction of the AST. Thus, we conclude that the introduction of the AST emergency call system has increased the number of eligible patients receiving rtPA. Improved onset-needle and door-needle times are achievable by this team approach.